Severe Monkeypox in Hospitalized Patients — United States, August 10–October 10, 2022

Abstract

us-map.html ¶ A list of severe manifestations of monkeypox can be found at https://emergency. cdc.gov/han/2022/han00475.asp. ** During the study period and as of October 21, 2022, CDC was notified by state and local jurisdictions of five decedents whose death certificates included monkeypox as a cause of death or contributing factor, six decedents whose cause of death is still under active investigation, and one decedent in whom the death was not monkeypox-related. Additional monkeypox cases involving severe disease or death might not be included in this report if CDC has not yet been notified about the case or if the case occurred outside of the study period.

Monkeypox

“… 13 During the 2022 outbreak, several people with HIV and CD4 counts of less than 200 cell per mL have presented with severe manifestations of monkeypox and some have died. 103 In contrast, studies in which most patients were receiving effective antiretroviral therapy (and had undetectable HIV RNA) have noted no evident excess in complications, hospital admissions, or deaths among people with HIV infection and monkeypox to date. 32 , 34 , 104 Two studies 32 , 34 that, respectively, had 241 and 72 people living with HIV found no differences in clinical features or clinical outcomes between people with or without HIV.…”

“… 13 , 14 During the 2022 outbreak, the case-fatality rate has been less than 0·1% (41 deaths have been reported of the 78 229 cases up to Nov 4, 2022); 30 a few of them were related to encephalitis 31 or in immunocompromised people. 103 …”

“…129 , 130 Early commencement and extended duration of therapy should be considered in highly immunocompromised patients, including people living with HIV with a CD4 count of less than 200, patients who had a solid organ transplantation, or patients with haematological malignancy. 103 Tecovirimat inhibits an orthopoxvirus protein that is essential for dissemination within an infected host. Human randomised controlled studies on the efficacy of tecovirimat are currently missing.…”

Epidemiologic Features of the Monkeypox Outbreak and the Public Health Response — United States, May 17–October 6, 2022

“…The current outbreak also continues to disproportionately affect persons with HIV infection (6). In light of data suggesting a higher risk for severe monkeypox disease among persons with advanced and uncontrolled HIV infection (6,7), it is recommended that persons with suspected monkeypox be offered HIV testing when they initially seek care.…”

Epidemiologic and Clinical Features of Children and Adolescents Aged <18 Years with Monkeypox — United States, May 17–September 24, 2022

“…However, the clinical signs and symptoms reported in children and adolescents in this report were broadly similar to findings from Spain and U.S. national surveillance data for cases overall ( 1 , 3 ), with most children experiencing a mild-to-moderate clinical course. Clinicians caring for children and adolescents should be aware of available clinical guidance for the diagnosis and treatment of monkeypox §§§ and of the potential for severe disease, particularly in persons with profound immunocompromise (e.g., those with advanced HIV disease or undergoing chemotherapy for cancer) ( 8 ).…”